South Carolina Department of Motor Vehicles
4057
Application for Name and/or Address Change, Date of Birth and/or Social Security Correction, or Special Mailing
(Rev. 4/06)
SC Code of Laws § 56-1-230 Notification of change of address or name. Whenever any person after applying for or receiving a driver’s license shall move permanently from the address named in such application or in the license issued to him or when the name of a licensee is changed by marriage or otherwise, such person shall within ten days thereafter notify the Department in writing of his old and new address or of such former and new name and of the number of any license then held by him.
Please check and complete all sections that apply in black ink. MY NAME ON RECORD WITH THE DEPARTMENT OF MOTOR VEHICLES IS: Name:
Last First Middle Suffix
Date of Birth: TITLE AND REGISTRATION INFORMATION
Customer No. License Plate No. Customer No. Identification Card No.
Vehicle Identification No. Make of Vehicle DRIVER RECORD INFORMATION Driver’s License No. Beginner Permit No.
NAME CHANGE (A court order or marriage license must accompany this form.) I hereby request that my name in the SCDMV records be changed to:
Last First Middle Suffix
RESIDENCE ADDRESS CHANGE - Address where you reside
or the address where the company is located. Cannot be a PO Box. My residence address is: Street City SCDMV to send you mail. My mailing address is: Street City State Zip Code County State Zip Code County
HOUSED ADDRESS CHANGE - Address used for a vehicle that
is primarily at an address different from the residence/company address. Example: company vehicle. My housed address is: Street City State Zip Code County
MAILING ADDRESS CHANGE – Address where you want
TEMPORARY ADDRESS CHANGE – Address where you will
receive your mail on a temporary basis. My temporary address is: Street City State Zip Code County Temp. Expiration Date
DATE OF BIRTH CORRECTION
Date of Birth Shown on Department Records Correct Date of Birth
Month Day Year Month Day Year Supporting documentation is required. Please see form MV-93 and MV-94 for a list of acceptable documents to justify the correction.
SOCIAL SECURITY NUMBER CORRECTION
Social Security Number Shown on Department Records Correct Social Security Number
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Supporting documentation is required. Please see form MV-93 and MV-94 for a list of acceptable documents to justify the correction. NOTE: State Election Commission requires the customer to be physically present in the DMV office to update MOTOR VOTER SECTION information with the Election Commission. Customers not transacting business in a DMV office should contact their County Board of Voter Registration to update voter registration information.
Yes, I wish to update my address with the Election Commission (customer must be physically present in DMV field office). No, I do not wish to update my address with the Election Commission
I hereby state that all information given and statements made herein are true and correct, and these changes are being made without fraudulent purpose or intent. Applicant’s Signature Signature of DMV Customer Service Representative Date Branch Office Name and Number
NOTE: Applications, with all needed supporting documents, may be mailed to:
S.C. Department of Motor Vehicles Alternative Media PO Box 1498 Blythewood, SC 29016-0035